Pancreatitis and Acalculous Cholecystitis Secondary to Lancereaux-Mathieu-Weil Spirochetosis Disease in an HIV Patient

Abstract

Leptospirosis is a zoonotic disease distributed worldwide, most commonly in the tropical and subtropical regions caused by the spirochete Leptospira spp. The incidence in the United States fluctuates from 1.63 to 2.85 per 100,000, with a mortality rate of 10% in the severe disease. This pathology develops after an incubation period of 5 - 14 days and ranges from a self-limiting disease to fulminant and catastrophic one, with the latter being named as Weil’s syndrome, which is characterized for the triad of jaundice, acute renal failure, and hemorrhage, affecting virtually every organ. We report a case of a 41-year-old Hispanic male with a medical history of HIV, hypertension and diabetes mellitus that arrived at the emergency room with unquantified fever, nausea, mild headache, multiple arthralgia and myalgia of 3 days of evolution. Patient was admitted to the internal medicine ward with a diagnosis of fever of unknown origin and systemic inflammatory response syndrome. During the admission, the patient deteriorated and was started on ceftriaxone with clinical improvement, although he developed severe abdominal pain. He was diagnosed with acalculous cholecystitis and acute pancreatitis, demonstrated by laboratories and imaging studies. We postulate that patients with a history of HIV that developed leptospirosis should be evaluated carefully with the expectation of development of multiple complications despite of adequate management. In countries lacking technologies for the early diagnosis of leptospirosis, the use of Faine’s criteria should be encouraged, which stratifies patients even only with clinical history and epidemiological factors. Medical literature lacks enough documentation about leptospirosis in HIV patients and we suggest further investigation in this population. Furthermore, survey investigation should be performed in urban and rural hospitals about the Faine’s criteria to assess general knowledge and implementation.




Clin Infect Immun. 2018;3(1):24-28
doi: https://doi.org/10.14740/cii72e